United Kingdom

(GDP) spent on health care: 8.3

Average family premium: None; funded by taxation.

Co-payments: None for most services; some co-pays for dental care, eyeglasses and 5 percent of prescriptions. Young people and the elderly are exempt from all drug co-pays.

What is it? The British system is "socialized medicine" because the government both provides and pays for health care. Britons pay taxes for health care, and the government-run National Health Service (NHS) distributes those funds to health care providers. Hospital doctors are paid salaries. General practitioners (GPs), who run private practices, are paid based on the number of patients they see. A small number of specialists work outside the NHS and see private-pay patients.

How does it work? Because the system is funded through taxes, administrative costs are low; there are no bills to collect or claims to review. Patients have a "medical home" in their GP, who also serves as a gatekeeper to the rest of the system; patients must see their GP before going to a specialist. GPs, who are paid extra for keeping their patients healthy, are instrumental in preventive care, an area in which Britain is a world leader.

What are the concerns? The stereotype of socialized medicine -- long waits and limited choice -- still has some truth. In response, the British government has instituted reforms to help make care more competitive and give patients more choice. Hospitals now compete for NHS funds distributed by local Primary Care Trusts, and starting in April 2008 patients are able to choose where they want to be treated for many procedures.

Japan

GDP spent on health care: 8

Average family premium: $280 per month, with employers paying more than half.

Co-payments: 30 percent of the cost of a procedure, but the total amount paid in a month is capped according to income.

What is it? Japan uses a "social insurance" system in which all citizens are required to have health insurance, either through their work or purchased from a nonprofit, community-based plan. Those who can't afford the premiums receive public assistance. Most health insurance is private; doctors and almost all hospitals are in the private sector.

How does it work? Japan boasts some of the best health statistics in the world, no doubt due in part to the Japanese diet and lifestyle. Unlike the U.K., there are no gatekeepers; the Japanese can go to any specialist when and as often as they like. Every two years the Ministry of Health negotiates with physicians to set the price for every procedure. This helps keeps costs down.

What are the concerns? In fact, Japan has been so successful at keeping costs down that Japan now spends too little on health care; half of the hospitals in Japan are operating in the red. Having no gatekeepers means there's no check on how often the Japanese use health care, and patients may lack a medical home.

Germany

GDP spent on health care: 10.7

Average family premium: $750 per month; premiums are pegged to patients' income.

Co-payments: 10 euros ($15) every three months; some patients, like pregnant women, are exempt.

What is it? Germany, like Japan, uses a social insurance model. In fact, Germany is the birthplace of social insurance, which dates back to Chancellor Otto von Bismarck. But unlike the Japanese, who get insurance from work or are assigned to a community fund, Germans are free to buy their insurance from one of more than 200 private, nonprofit "sickness funds." As in Japan, the poor receive public assistance to pay their premiums.

How does it work? Sickness funds are nonprofit and cannot deny coverage based on preexisting conditions; they compete with each other for members, and fund managers are paid based on the size of their enrollments. Like Japan, Germany is a single-payment system, but instead of the government negotiating the prices, the sickness funds bargain with doctors as a group. Germans can go straight to a specialist without first seeing a gatekeeper doctor, but they may pay a higher co-pay if they do.

What are the concerns? The single-payment system leaves some German doctors feeling underpaid. A family doctor in Germany makes about two-thirds as much as he or she would in America. (Then again, German doctors pay much less for malpractice insurance, and many attend medical school for free.) Germany also lets the richest 10 percent opt out of the sickness funds in favor of U.S.-style for-profit insurance. These patients are generally seen more quickly by doctors, because the for-profit insurers pay doctors more than the sickness funds.

Taiwan

GDP spent on health care: 6.3

Average family premium: $650 per year for a family for four.

Co-payments: 20 percent of the cost of drugs, up to $6.50; up to $7 for outpatient care; $1.80 for dental and traditional Chinese medicine. There are exemptions for major diseases, childbirth, preventive services, and for the poor, veterans, and children.

What is it? Taiwan adopted a "National Health Insurance" model in 1995 after studying other countries' systems. Like Japan and Germany, all citizens must have insurance, but there is only one, government-run insurer. Working people pay premiums split with their employers; others pay flat rates with government help; and some groups, like the poor and veterans, are fully subsidized. The resulting system is similar to Canada's -- and the U.S. Medicare program.

How does it work? Taiwan's new health system extended insurance to the 40 percent of the population that lacked it while actually decreasing the growth of health care spending. The Taiwanese can see any doctor without a referral. Every citizen has a smart card, which is used to store his or her medical history and bill the national insurer. The system also helps public health officials monitor standards and effect policy changes nationwide. Thanks to this use of technology and the country's single insurer, Taiwan's health care system has the lowest administrative costs in the world.

What are the concerns? Like Japan, Taiwan's system is not taking in enough money to cover the medical care it provides. The problem is compounded by politics, because it is up to Taiwan's parliament to approve an increase in insurance premiums, which it has only done once since the program was enacted.

Switzerland

GDP spent on health care: 11.6

Average monthly family premium: $750, paid entirely by consumers; there are government subsidies for low-income citizens.

Co-payments: 10 percent of the cost of services, up to $420 per year.

What is it? The Swiss system is social insurance like in Japan and Germany, voted in by a national referendum in 1994. Switzerland didn't have far to go to achieve universal coverage; 95 percent of the population already had voluntary insurance when the law was passed. All citizens are required to have coverage; those not covered were automatically assigned to a company. The government provides assistance to those who can't afford the premiums.

How does it work? The Swiss example shows that universal coverage is possible, even in a highly capitalist nation with powerful insurance and pharmaceutical industries. Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. They can make money on supplemental insurance, however. As in Germany, the insurers negotiate with providers to set standard prices for services, but drug prices are set by the government.

What are the concerns? The Swiss system is the second most expensive in the world -- but it's still far cheaper than U.S. health care. Drug prices are still slightly higher than in other European nations, and even then the discounts may be subsidized by the more expensive U.S. market, where some Swiss drug companies make one-third of their profits. In general, the Swiss do not have gatekeeper doctors, although some insurance plans require them or give a discount to consumers who use them.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

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You may be able to watch it here if it's blocked.

*documentaries

Adding video to channels (Documentaries) - requested by kronosposeidon.

Let's see... Funded by Colorado Health, The Commonwealth Fund, and Colorado Trust - all organizations who openly support government subsidized health care...? Broadcast on a government subsidized TV channel...? Gee - I wonder what sort of bias this particular piece of propoganda will have? :eyeroll:

You can talk about Japan or Canada all you want, but that doesn't change the fact that government involvement in health care is a terrible idea. We already have proof that the U.S. government is neither competent at, nor capable of running a health care program with any degree of effectiveness or efficiency. Viewing a slanted advocacy piece doesn't change the facts.

Medicare/Medicaid alone already takes up 23% of the US budget and only covers 15% of the population. Adding a 1.3 trillion health care plan on top of that will bring federal budget spending on health care to over 2 trillion dollars a year. And it still won't cover 100% of the population. Democrat Health Care reform isn't about covering people. It's about increasing government. No thanks. And no thanks to government funded propoganda TV. If we want to save some goverment money, how about eliminating PBS?

>> ^eric3579:
Germany also lets the richest 10 percent opt out of the sickness funds in favor of U.S.-style for-profit insurance. These patients are generally seen more quickly by doctors, because the for-profit insurers pay doctors more than the sickness funds

And that, my friends, will break the neck of the German healthcare system.

At least that's what I would have told you before our new government was elected. If, on average, the richest and healthiest people can opt out of the public system, it doesn't work. It can't work, because it's based on the idea that the strong take care of the weak and if the strong leave, the whole fucking thing collapses.

Our system had its 125th anniversary last year. It dates back to a law passed on June 15th, 1883, and was based around two primary ideas: a) employer and employee both pay an equal share of the health insurance, b) the premium is based on your income. The new government now intends to throw both out the window by "freezing" the employer's part - the employee will have to pay for every increase alone - and introducing a fixed premium for everybody. The doctor will pay the same as the orderly. Any additional costs are to be paid with tax money while lowering taxes at the same time. That's an estimated 22 billion euro a year for healthcare alone that will have to come from somewhere. 22 billion: that's twice than what is paid for education every year, just to cap the premiums of people with high(er) incomes.

Costs are increasing as well. More and more hospitals are privatized, which then have to generate a profit, just like the insurance companies and the pharma industry. German healthcare costs were around 10% of GDP since 1975, yet they still claimed year after year after year that costs are increasing and thus premiums have to increase as well. It's been a lie then, but it's true now. Pay more, get less.

So if you want to see how a working system can be ruined to make a profit for some, read up on what they've done to the German system over the last decade and keep an eye out on what they are about to do. It would be a fascinating field experiment if I wasn't a bloody test subject.

not sure if this is a dupe or not, as this particular sift is region-blocked for me

http://www.videosift.com/video/Healthcare-in-the-US-vs-Canada-Europe-and-Asia#comment-564189

...but my comment on taiwan's nationalized healthcare system still stands -- and having watched 'sick around the world' i can tell you that what they're reporting for taiwan is misrepresented, and perhaps even intentionally deceptive

*quality

Boosting this quality contribution up in the Hot Listing - declared quality by JiggaJonson.

>> ^eric3579:


You forgot one!

United States

GDP spent on health care: 16.0%

Average monthly family premium: $1,100, with some employers paying a portion

Co-payments: Varies, can be as low as $10 co-pay with other costs covered at 100% for HMO in-network, or with HDHP you pay out of pocket until the deductible is met, with deductibles falling somewhere in the $4,000-$12,000 range. You are also given the option to not get sick, or to save up lots of money just in case you do.

What is it? If you're 65 and older, single-payer. If you're a veteran, it's socialized medicine. If you work for an employer with benefits, it's whatever they've decided to offer. If you don't get employer insurance, and you're healthy you may be able to buy overpriced individual insurance, with no guarantee that the contract will be honored. If you're seriously ill, you will be paying out of pocket. It's the Ayn Randian ideal of economic eugenics, minus the bit where people can escape it if they survive to 65, or join the military.

How does it work? Poorly. We spend the largest portion of our GDP for healthcare, but our basic health statistics (e.g. life expectancy, infant mortality, etc.) are nearly 3rd-world. There are certain procedures that the US does better than other countries, such as organ transplants and boob jobs, but our overall ability to deliver care is no better than other countries that spend much less. The US does not have anywhere near universal coverage, with over 15% of our population without insurance of any kind, and many of those who do face denied claims or rescinded policies if they become seriously ill. On the bright side, the profits in the US health industry are second to none.

What are the concerns? All trends point to the situation only getting worse. Costs continue to grow faster than in any other nation. Due to a lack of a national guarantee of universal coverage, this leads to a steady increase in the number of uninsured. Insurance policies themselves are becoming more and more limiting, with denials of coverage becoming a regular occurrence, while premiums continue to rise apace.

What about reform? We're thinking about setting up something less intrusive than Switzerland, and they're calling our President a Nazi. Aside from that, it's going swell. We will probably end up with a system that's a bit of a hybrid of the Swiss and German systems -- no government mandated pricing (aside from Medicare), but we are likely to end up with nonprofit, privately run sickness funds (co-ops), as well as a nonprofit, government run sickness fund (teh public option). However, as it stands, only the unemployed and people working for small businesses will be allowed to purchase plans either through the co-ops or public option (and only then if their small business chooses not to provide a group plan). Most will receive coverage from mandated employer coverage, which includes a minimum requirement for the quality of the employer provided plan. People will still be permitted to forgo insurance altogether, but they will need to pay a penalty/excise tax for doing so.

There's almost certainly too little in the plan to control costs, but it should improve the quality of life for millions, and help bump up our OECD stats to the level of our economic peers.

Eventually the people who own our country will realize that upwards of 20% GDP on healthcare isn't worth it, and will inflict cost controls on us one way or another. You can choose the free-market eugenic path of "if you can't afford it, hurry up and die" or you choose the path where we try to come up with some fair, medically-based rules for how we provide care to cut costs (aka *scary voice* SOCIALISM!!!).

^I keep forgetting I'm a veteran so I have lifetime socialized medicine! YAY! ME! ME! ME! I think my experience in the military was bad enough that I wouldn't want to voluntarily go back to one of those hospitals. Also, somehow it makes me feel like a freeloader seeing how I never fought in a war or saw any action.

No need for health care in a nation of healthy people-Stop eating shit, stop needing doctors. Re-educate people "What is poisonous?"-a good introductory question for the first day of class.... Goddamn NetRunner, long-winded diatribes are as ineffectual as voting for a president.


You need trauma care in he US, you get it....otherwise yer a fat, unhealthy, dumb ass, or bound for ill-health because of genetics, diet, or exposure to toxicity.

Peoples' brains need help first, then provide them some health care.

^Rorschach.

No shit BF, the best character in Watchmen. Practical, efficient, caring and considerate, and tenacious.

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